AB 956

This bill exempts valid direct primary care agreements from the application of

insurance law. A direct primary care agreement, as defined in the bill, is a contract

between a health care provider that provides primary care services under the

provider's scope of practice and an individual patient, or his or her legal

representative, or an employer in which the health care provider agrees to provide

primary care services to the patient or employee for an agreed-upon subscription fee

and period of time. A valid direct primary care agreement is signed and in writing

and does all of the following: 1) allows either party to terminate the agreement upon

written notice and specifies the terms for termination and the subscription fee; 2)

describes and quantifies the specific primary care services that are provided under

the agreement; 3) specifies the duration of the agreement; 4) prominently states that

the agreement is not health insurance and may not satisfy insurance coverage

requirements under federal law; 5) prohibits the provider and patient from billing

an insurer or any other third party on a fee-for-service basis for the primary care

services included in the subscription fee under the agreement; 6) prominently states

that the individual patient, or employer if applicable, is responsible for paying the

provider for all services that are not included in the subscription fee under the

agreement; and 7) prominently states that the patient is urged to consult with any

health insurance carrier the patient has before entering the agreement, that some

services provided under the agreement may be covered by any health insurance the

patient has, and that direct primary care fees may not be credited toward deductibles

or out-of-pocket maximum amounts under any health insurance the patient has.

Under the bill, a health care provider may not decline to enter into or may not

terminate a direct primary care agreement with a patient solely because of the

patient's health status. The bill allows a health care provider to decline to accept a

patient for a direct primary care agreement only if the health care provider's practice

has reached its maximum capacity or if the patient's medical condition is such that

the health care provider is unable to provide the appropriate level and type of

primary care services the patient requires. A health care provider is allowed to

terminate a direct primary care agreement with a patient only if the patient fails to

pay the subscription fee or fails repeatedly to adhere to the treatment plan, the

patient has performed an act of fraud or is abusive in a manner described in the bill,

the health care provider discontinues operation as a direct primary care provider, or

the health care provider believes that the relationship is no longer therapeutic for

the patient due to a dysfunctional relationship between the provider and the patient.